What antibiotic ointment is recommended for facial infections?

Antibiotic Ointment for Facial Infections

For facial skin infections, mupirocin ointment applied twice daily is the recommended first-line topical antibiotic, particularly for limited impetigo lesions. 1, 2

First-Line Topical Treatment

• Mupirocin ointment applied to lesions twice daily for 7-10 days is the gold standard for limited facial impetigo and superficial infections 1, 2
• Retapamulin ointment applied twice daily is an alternative for patients with limited lesions 1, 2
• Triple-antibiotic ointment (bacitracin/neomycin/polymyxin B) is available over-the-counter but is considerably less effective than mupirocin 1, 3, 4

Important Caveat on Triple-Antibiotic Ointments

• While triple-antibiotic ointments (Neosporin) are widely available, the IDSA guidelines explicitly state they are "considerably less effective" than mupirocin for treating impetigo 1
• Neomycin carries a higher risk of allergic contact dermatitis compared to mupirocin 5
• These products are better suited for minor wound prophylaxis rather than active infection treatment 6, 7

When Topical Therapy Alone Is Insufficient

Oral antibiotics should be initiated when:

• Numerous lesions are present 1, 2
• Facial involvement is extensive 1, 2
• No response to topical mupirocin after 3-5 days 2
• Systemic signs of infection develop 1

Recommended Oral Antibiotics for Facial Infections

For presumed streptococcal erysipelas (fiery red, well-demarcated facial plaque):

• Penicillin V 500 mg four times daily is the treatment of choice 1
• This presentation is classically caused by Streptococcus pyogenes 1

For impetigo or cellulitis (mixed staphylococcal/streptococcal):

• Cephalexin 250-500 mg four times daily (adults) or 25-50 mg/kg/day in 4 divided doses (children) 1, 2
• Dicloxacillin 250 mg four times daily (adults) 1, 2
• Amoxicillin-clavulanate 875/125 mg twice daily (adults) or 25 mg/kg/day in 2 divided doses (children) 1, 2

If MRSA is suspected (treatment failure, known MRSA prevalence, or culture-confirmed):

• Clindamycin 300-450 mg three times daily (adults) or 10-20 mg/kg/day in 3 divided doses (children) 1, 2
• Trimethoprim-sulfamethoxazole 1-2 double-strength tablets twice daily (adults) or 8-12 mg/kg/day in 2 divided doses (children) 1, 2
• Doxycycline 100 mg twice daily (not for children under 8 years) 1, 2

Critical Pitfalls to Avoid

• Never use penicillin alone for impetigo - it lacks adequate S. aureus coverage 2
• Avoid macrolides (erythromycin) due to increasing resistance rates 1
• Facial wounds from bites require special consideration - primary closure should be performed with copious irrigation, cautious debridement, and preemptive antibiotics covering oral flora 1
• Mupirocin resistance is emerging, particularly in areas with high MRSA prevalence; if treatment fails, obtain cultures and switch to oral therapy 2

Special Facial Infection Considerations

• Most facial erysipelas infections are caused by Group A Streptococcus, while lower extremity infections increasingly involve non-GAS organisms 1
• Facial cellulitis warrants more aggressive treatment due to proximity to critical structures and cosmetic concerns 1
• For facial bite wounds specifically, use amoxicillin-clavulanate to cover Pasteurella multocida and oral anaerobes 1